The lowdown on eating well after cancer

“Have you tried wheatgrass? How about kale smoothies?”

There is unlikely to be a cancer patient out there who hasn’t been on the receiving end of diet or nutrition advice – whether they asked for it or not. But what does “eating well” actually mean, and how can we do it? And does being healthy mean going raw or cutting out all the fun stuff (Gwyneth Paltrow, we’re looking at you!)?

Last month, we asked the members of our private Facebook group what questions they had about diet and nutrition and we were thrilled that registered dietician Victoria Francis took on the challenge of responding to them!  In her first blog for us, she’s answered 10 of questions and also given us a few healthy recipes (scroll to the bottom if you just want these).  Take a read and let us know what you think. Please do share the post – and share any yummy recipes you have with us as well!


1. You’re a registered dietitian. Can you tell us the difference between a dietitian and a nutritionist?

The key differences are the qualifications and regulations imposed on the two titles.

victoria-francis

Guest blogger and registered dietitian Victoria Francis

Dietitians are the only nutrition professionals regulated by law and governed by an ethical code. This means that dietitians will always work to the highest standard, using the most up-to-date public health and scientific research on food, health and disease when advising people. Currently, due to a lack of regulation, anyone can practice under the title of nutritionist/nutritional therapist/nutrition advisor/ nutritional coach (etc., etc.!). There are many qualified nutritionists, some of who are also registered dietitians.  By no means am I suggesting you shouldn’t seek advice from a nutritionist – but you should check that they are registered with a professional body such as the UK Voluntary Register for Nutritionists.

Dietitians primarily work in a clinical setting in the NHS or the private sector in a variety of settings. Seeking advice from a Registered Nutritionist or Registered Dietitian is the gold standard and you can be assured that all advice discussed will be based on scientific evidence – not pseudo-science! Below, I’ve outlined the qualifications and registration with governing bodies the different nutrition titles need:

Dietitian
Qualification: BSc Hons. in Dietetics, or a related science degree with a postgraduate diploma or higher degree in Dietetics.
Governing body: Health Care and Professions Council

Registered nutritionist
Qualification: Undergraduate or post-graduate nutrition degree
Governing body: Association for Nutrition

Nutritionist/Nutritional Therapist/Holistic Food Coach
Qualification: None
Governing body: None

2. I’m looking for nutrition advice. How do I know that someone is legitimate and knows what they’re talking about?

To guarantee that the advice you receive is credible and evidence-based check what professional body people are registered with and what up-to-date insurance they have. In order to practice as a dietitian, a person has to be registered with the Health Care and Professions Council. Dietitians can also be found on the Freelance Dietitians website (www.freelancedietitians.org). This website lists all the dietitians registered with the HPC.

When looking for a nutritionist ensure they are registered with the UK Voluntary Register for Nutritionists (regulated by the Association for Nutrition).

3. So, what do you think about “clean eating”? 

Clean eating is facing a huge backlash in the media by health professionals who have a big issue with what it stands for and what it can create. The fundamental problem with clean eating is that it is not evidence-based. Food and health bloggers who promote clean eating tend not have any nutritional qualifications but rather want to share their own experiences. This isn’t science!clean-eating

The essence of “clean eating” is flawed as it suggests there is a single perfect way of eating which is essentially setting people up to fail. There are numerous “rules” such as the removal of whole food groups including dairy and gluten, which can lead to very restricted diets with likely nutritional deficiencies. Unless you have Coeliac disease you will not benefit from removing gluten from your diet. Many “clean eating” advocates advise you to replace sugar with “healthier alternatives” such as coconut sugar or maple syrup. To set the record straight: these are all sugar! The body will handle them all in exactly the same way. They are not a superior alternative, just a very expensive one!

Following a “set of rules”, for some people, can impact on their mental health. If they don’t conform to the rules then they feel that they have failed. If you want to eat healthier, reach your 30g fibre a day, reduce your sugar intake, etc. then go back to the basics. Its not sexy or new but it is realistic and achievable. Try to use fresh ingredients where possible, watch your intake of fat and sugar, and look at your eating habits. Aim for small realistic changes.

4. What are your thoughts on processed and fermented foods – especially processed meats and products like Actimel?

What do you think of when you hear the words “processed food”? Most of us think of unhealthy, high fat, high sugar and salty foods. While this may be true for some processed foods, there are many that provide good nutrition also.

Processed foods are “any food that has been altered from its natural state for either safety reasons (e.g. milk is pasteurised to remove bacteria), convenience or to preserve the availability of nutrients”. So breakfast cereals, cheese, milk, yogurts, bread, and tinned and frozen vegetables can all be called processed foods but do we don’t typically consider them unhealthy.

If we focus on red meat, there has been some recent guidance on how much we should be eating. The Department of Health has advised that people who eat more than 90g (cooked weight) of red and processed meat a day to cut down to 70g per day (or 500g per week). This is equivalent to two or three rashers of bacon, or a little over two slices of roast lamb, beef or pork, with each about the size of half a slice of bread.

Some fermented foods, such as yogurts, are sources of probiotics. The research into the health benefits of friendly bacteria from fermented foods is ongoing but evidence does show a healthy gut flora plays an important role in immunity and may offer protection against infections.

5. If you’re fighting fatigue and looking for an energy boost, what foods would you recommend (aside from sugar and caffeine!)?

Before we look at specific foods we need to first take a look at eating patterns. A slump in energy can be a sign that your blood sugar level has dropped a little. Eating little and often (e.g. three small meals with a couple of healthy snacks in between) can ensure that your energy and blood sugar levels are topped up. Try to eat something every 3-4 hours.

The foods you choose have a big impact on your energy levels and many of us fall for the “quick sugar fix” but when you’re looking for an energy boost you need the right balance of carbohydrates and protein.

When choosing carbohydrates, choose foods with a low Glycaemic Index (GI) such as lentils, oats, nuts, seeds, wholegrain bread, and brown pasta. These foods are broken down slowly by the body and their energy is released over a longer period of time whereas foods with a high GI (think sugar, honey, fizzy drinks, white bread, potatoes) are broken down quickly and the sugar released quickly. Protein is also known to be broken down slowly so adding protein to a carbohydrate snack/meal will ensure a slower release of energy

Good snack ideas include cheese and apple, a handful of nuts and fruit, a slice of wholegrain bread or oatcakes with hummus/nut butters/boiled egg, and Greek yogurt with fruit and sprinkling of seeds such as pumpkin or sunflower.

Also, make sure you stay hydrated! Dehydration is thought to be the cause of one in 10 cases of unexplained tiredness. Alcohol also dehydrates you. Aim for 6-8 glasses of fluid per day.

 6. A lot of people claim that sprouting foods like alfalfa and broccoli are extremely high in nutrients. Is this true?

Sprouting is the process whereby seeds germinate and are eaten either raw or cooked. Bean sprouts tend to be the first that come to mind when we think of sprouting but many foods can be sprouted including barley, wheat, spelt, rye, oats, lentils, peas, and pinto and kidney beans, sesame and sunflower seeds, almonds and broccoli.

These foods are all nutrient rich but are not always superior to their non-sprouted counterpart. Rather than focusing on sprouting seeds, a good starting point is to aim for your five-a-day and to include more plant-based foods in your diet where possible. This can be done by adding nuts and seeds to your salads or adding beans to your soups and stews etc.

7. If you’re looking to boost your iron intake, what foods would you recommend?

Iron is an important mineral, needed to make red blood cells which carry oxygen around the body.  Simple ways to boost your iron levels include:

  • Consuming iron rich foods such as red meat, fish, poultry, beans such as kidney or haricot, eggs and fortified breakfast cereals daily.
  • Adding a handful of nuts or seeds such to your bowl of cereal, your pot of yogurt or salads.
  • Ensuring you have fruit and/or vegetables with every meal as vitamin C helps your body to absorb iron. You could have a small glass of juice with your breakfast, a bowl of fruit salad after your meals or just an extra helping of leafy green vegetable such as kale with your meals.
  • Try adding haricot or kidney beans to your stew or soup to bump up the iron. A great tasty alternative to mashed potato is parsnip and cannellini bean mash.
  • Eating breakfast cereals are fortified with iron (except for muesli and granola).
  • Adding a boiled an egg or two to your breakfast for an iron boost. Or take a boiled egg for a snack later in the day

Some foods can make it harder for your body to absorb the iron in your diet such as tea and coffee (due to tannins), milk and some wholegrains. Try to avoid drinking tea or coffee at least 1 hour either side of your meal.

8. If you’re avoiding sugar, are alternatives like honey a good idea?

In a word, no.

“Sugar” loosely refers to several sweet carbohydrates such as monosaccharides, disaccharides or oligosaccharides. The sugar that you put in your tea or on your cereal is made up of two simple monosaccharide units (glucose and fructose) joined together to form the disaccharide sucrose. Honey similarly contains both glucose and fructose and has similar caloric content to sugar. Honey and maple syrup are often promoted as “natural” or “unprocessed” and therefore healthier or superior. But sugar is a natural product, made from sugar beet and sugar cane. The body does not differentiate between maple syrup, coconut sugar etc. and so all of them still raise blood sugar levels similarly to sugar.

Instead of searching for a “healthier alternative”, a starting point could be reducing the cereal-fruitoverall amount of sugar your currently use. You can do this by gradually reducing the amount of sugar you have in your tea or, if you like honey on your porridge, try adding stewed fruit instead.

9. What are your thoughts on raw food diets?

The principle behind raw food diets is that all foods should be unprocessed, unrefined and not heated to above 44c. The theory is that if the enzymes within foods are preserved, this will aid digestion and offer health benefits to your body. Foods allowed on a raw diet therefore includes whole foods such fresh fruit and vegetables, nuts, seeds, sprouted grains and some pulses and grains. Raw diets are largely vegan, although some advocates do include raw unpasteurized milk, raw meat and raw fish.

So, does the evidence stack up? It is widely agreed that a diet rich in plant-based foods including fruit, vegetables, nuts, seeds, legumes and pulses, with less reliance on meat and fish, can offer protection against some diseases such as cancer and heart disease. BUT the evidence is scarce for choosing uncooked, raw foods only. In fact, we know that cooking increases the bioavailability of some nutrients such as lycopene (highest concentration in cooked tomatoes) and betacarotene (carrots).

Choosing a raw food diet could put you at risk of specific nutritional deficiencies including vitamin B12 (found mainly in animal products), calcium and iron, and protein intakes tend to be low on such a diet.

Coconut oil is often promoted on raw diets, but despite the recent health claims, coconut oil is still 90% saturated fat. Eating uncooked foods or unpasteurized milk/cheese should be avoided if you have a compromised immune function and, from a food safety point of view, eating uncooked foods can put you at risk of food poisoning.

Another fad diet? I think so! Take the sensible principles such as increasing your intake of plant-based foods but have an extra portion of pumpkin seeds sprinkled over your pan-fried salmon salad.

10 Do you have any tips on sneaking in your 5 a day?

Before we discuss how to reach your 5 a day lets remind ourselves what is classed as a portion.

The following class as a portion (80g):

  • 1 medium sized piece of fruit e.g. 1 apple/orange
  • 2 small fruits e.g. 2 plums
  • 80g beans and pulses such as chick peas, kidney beans
  • 80g fresh, frozen or tinned vegetables
  • 30g dried fruit

berries-and-porridgeThe obvious way is to reach your 5-a-day is to choose fruit or vegetables as a snack. As much as I know this, however, I personally like a biscuit with my cuppa…so I need to ensure my meals are packed with portions of fruit or vegetables. Here are a few tips:

  • Add chopped dates, apricots or stewed apples to a bowl of porridge. Add sliced strawberries to your bran flakes or banana to your Weetabix.
  • Make pancakes with added blueberries in the mixture.
  • Have chopped crudités with your sandwich at lunch such as cherry tomatoes (x8) or carrot sticks (1/2 medium carrot)
  • Serve all main meals (where appropriate) with a side salad
  • Add a tin of haricot beans or chickpeas to slow cooker meals
  • Mix mashed potato with a tin of cannellini beans for a Shepherd’s pie topping or mix mashed carrot and swede.
  • Try to have have three different vegetables with your main meal.
  • Bulk out your Bolognese mix with a good couple of handfuls of frozen vegetables (this means the meat goes further, you lower the fat, and you increase the fibre too!)
  • Make your own tomato sauce with fresh or tinned tomatoes, chopped carrots, courgettes, onions and herbs. Once blitzed no one will know!
  • Remember that soup is such a great vehicle for veggies.

If you are struggling for a healthy snack then below is a recipe for a fruit and nut bar that I like to make. The combination of whole grains, fruit, nuts and protein make for a healthy, nutritious and sustaining snack!

Nutritious nut, fruit and oat barbars

Ingredients
100g dates
50g semi-soft apricots (chopped)
50g walnuts (chopped)
1 tbsp sunflower seeds
150g oats
60g ground almonds
100g honey
100g low sugar/salt peanut butter

Method

  1. Heat dates in a saucepan with a few tablespoons water until soft and then mash (you may need to add more water)
  2. Heat honey and peanut butter gently in a pan and then add oats, almonds, apricots, walnuts and seeds.
  3. Add dates and stir well
  4. Spread into greaseproof paper lined baking tray and press down firmly
  5. Bake at 160 for @20 minutes
  6. Remove and leave to cool completely before cutting into squares


Midweek meatloaf

This meatloaf uses turkey mince instead of beef, so it’s a great choice if you are trying to reduce your red meat intake. The basic recipe was inspired by a recipe on the BBC Good Food website but I tweaked it to boost the nutrient content. I use whole grain oats and oatmeal to increase the fibre content and whole grains and more tomato puree (an excellent source of the antioxidant lycopene) than originally suggested.

Ingredients
500g turkey mince
1 large onion
2 garlic cloves
1 tsp Dijon mustard
2 tbsp tomato puree
Dried oregano
75g old fashioned oats
25g oatmeal
1 egg, beaten

Method

Pan fry onion and garlic cloves in rapeseed or olive oil until soft (5 minutes). Then combine with all other ingredients and place into a prepared loaf tin (greased or use greaseproof paper). Cook at 180C (160C fan) for 30 to 40 minutes. Serve with green vegetables and potatoes.

Victoria is a freelance dietitian who splits her time between NHS work, her private practice and bringing up her young family. She firmly believes that when it comes to diet and nutrition there is no “one-size-fits-all” approach. She works with clients to help them achieve their diet and lifestyle goals, using evidence based nutrition advice!

For more information about her services see her website here.  You can follow her on Twitter here or on Instagram here

 

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